Key Words Myocardial infarction, pathophysiology Ventricular function Reperfusion Ejection fraction Follow-up studies

Transcription

1 J Cardiol 2 Oct; 4 : : Serial Assessment of Right Ventricular Function in the Acute and Convalescent Stages After Successful Reperfusion: Relationship to Infarct-Related Coronary Artery Tadamichi Yasuhiko SAKUMA, MD HAYASHI, MD, Abstract Objectives. To elucidate the relationship between the infarct-related coronary artery and the right ventricular function before and after successful recanalization. Methods. Hemodynamics and right ventricular function were measured using a REF-1 thermodilution catheter before and shortly after recanalization and during the convalescent stage in 35 patients, 17 with anteroseptal and 18 with inferior acute myocardial infarction. Results. Pulmonary arterial pressure significantly decreased in both anteroseptal and inferior myocardial infarction patients after recanalization. Right ventricular volume index in patients with anteroseptal myocardial infarction increased after recanalization, but again decreased during convalescence. The right ventricle became enlarged in patients with inferior myocardial infarction to maintain the right ventricular stroke volume constant. Right ventricular ejection fraction RVEF did not significantly change in patients with inferior myocardial infarction during convalescence 38 13%, 38 13%, 46 9%, whereas RVEF in patients with anteroseptal myocardial infarction temporarily decreased after recanalization, and then increased during convalescence 37 %, 31 12%, 41 7%. Patients with inferior myocardial infarction were divided into two groups, patients with increased RVEF n 6 and decreased RVEF n 12 shortly after recanalization. Patients with increased RVEF showed significantly improved RVEF during convalescence 49 7% vs 37 6%, p.5. The increase in RVEF shortly after recanalization in patients with inferior myocardial infarction was an independent factor for predicting RVEF during convalescence. Conclusions. Patients with anteroseptal myocardial infarction showed a different pattern of change in the right ventricular function during the acute and convalescent stages. An early change in RVEF in patients with inferior myocardial infarction can predict RVEF in the convalescent stage. J Cardiol 2 Oct ; 4 : Key Words Myocardial infarction, pathophysiology Ventricular function Reperfusion Ejection fraction Follow-up studies 1 2 Gil 3 12 % : ; Cardiovascular Division, Department of Internal Medicine, Medical Center, University of Virginia, USA Division of Cardiology, Tsuchiya Hospital, Hiroshima ; present Cardiovascular Division, Department of Internal Medicine, Medical Center, University of Virginia, USA Address for correspondence : SAKUMA T, MD, Cardiovascular Division, Department of Internal Medicine, Box 8158, Medical Center, University of Virginia, Charlottesville, VA 2298, USA Manuscript received April 22, 2; revised July 16, 2; accepted July 24, 2 137

2 138 6% % 58% mg Thrombolysis in Myocardial Infarction TIMI TIMI 2 3 7% ST 3 2 : U/kg Seldinger 8F Swan- Ganz thermodilution ejection fraction volumetric REF-1 Baxter Healthcare Corp. REF- 1 21cm 1 2cm REF-1 ml REF-1American Edwards Laboratories 3 TIMI U Rentrop 4 3 Student t 2 Fisher p.5 Table 1 TIMI J Cardiol 2 Oct; 4 :

3 139 Table 1 Baseline and clinical characteristics Anteroseptal Infarct region Inferior p value Number of patients Age yr Male Systemic hypertension Current smoker Diabetes mellitus Hypercholesterolemia Collateral circulation /1/2/3 Percutaneous transluminal coronary angioplasty Time from onset of symptoms to recanalization min Creatine phosphokinase peak : IU/l Diameter stenosis %; day 1, before recanalization Diameter stenosis %; day 1, after recanalization Diameter stenosis %; 3 weeks after recanalization TIMI flow grade 2 and 3 day 1, after recanalization Extent of diseased vessels 1/2/3 LVEF %; day 1, before recanalization LVEF 3 weeks after recanalization /4/4/ ,248 2, , 13 14, 1, /1/7/ ,568 1, , 12 16, 2, Continuous values are mean SD. : %. TIMI Thrombolysis in Myocardial Infarction ; LVEF left ventricular ejection fraction. Anteroseptal myocardial infarction Before recanalization After recanalization Absolute change Three weeks after recanalization Inferior myocardial infarction Before recanalization After recanalization Absolute change Three weeks after recanalization Table 2 Hemodynamics and cardiac function PA S PA D PCWP HR CI RVEDVIRVESVI RVSVI RVEF mmhg mmhg mmhg beats/min l/min/m 2 ml/m 2 ml/m 2 ml/m 2 % Values are mean SD. PA S systolic pulmonary arterial pressure ; PA D diastolic pulmonary arterial pressure ; PCWP pulmonary capillary wedge pressure ; HR heart rate ; CI cardiac index ; RVEDVI right ventricular end-diastolic volume index ; RVESVI right ventricular end-systolic volume index ; RVSVI right ventricular stroke volume index ; RVEF right ventricular ejection fraction Table 2 Fig. 1 J Cardiol 2 Oct; 4 :

4 1 Fig. 1 Pulmonary arterial systolic and diastolic pressure, pulmonary capillary wedge pressure, and cardiac index before and shortly after recanalization and 3 weeks after recanalization No significance, p.5. Abbreviations as in Table 2. p.4 Fig. 2 Fig Fig % 43 % 49 7% 42 14% 29 15% 37 6% J Cardiol 2 Oct; 4 :

5 141 Fig. 2 Right ventricular end-diastolic volume index, right ventricular end-systolic volume index, and right ventricular stroke volume index before and shortly after recanalization and 3 weeks after recanalization No significance, p.5. Abbreviations as in Table 2. RVEF RVEF Fig. 3 Right ventricular ejection fraction before and shortly after recanalization and 3 weeks after recanalization No significance, p.5. Abbreviation as in Table 2. J Cardiol 2 Oct; 4 :

6 142 Fig. 4 TIMI F 4. F F Serial changes in right ventricular ejection fraction in six patients with increased right ventricular ejection fraction n 6 and in eight patients with decreased right ventricular ejection fraction n 12 shortly after recanalization No significance, p.5. first pass gated nuclear technique 5 Fujiwara Siniorakis 9 Hirsowitz Walton % 58 % 5% J Cardiol 2 Oct; 4 :

7 143 6, 12 V 4R.1mV ST Q 13 X 18 2 Hirowitz Zhang 14 88% Schuler % % % 38 13% % Braat Yasuda ,18 : : REF-1 : 38 13% 38 13% 46 9% 37 % 31 12% 41 7% 6 J Cardiol 2 Oct; 4 :

8 % 37 6% p.5 :. J Cardiol 2 Oct; 4 : Schuler G, Hofmann M, Schwarz F, Mehmel H, Manthey J, Tillmanns H, Hartmann S, Kubler W : Effect of successful thrombolytic therapy on right ventricular function in acute inferior wall myocardial infarction. Am J Cardiol 1984 ; 54: Nemerovski M, Shah PK, Pichler M, Berman DS, Shellock F, Swan HJ : Radionuclide assessment of sequential changes in left and right ventricular function following first acute transmural myocardial infarction. Am Heart J 1982 ; 4: Gil VM, Ferreira J, Mendes M, Seabra-Gomes R : Relationship between radionuclide right ventricular ejection fraction and clinical status in patients with left ventricular dysfunction after myocardial infarction. Rev Port Cardiol 1999; 18 : Cohen M, Rentrop KP: Limitation of myocardial ischemia by collateral circulation during sudden controlled coronary artery occlusion in human subjects : A prospective study. Circulation 1986; 74 : Dhainaut JF, Brunet F, Monsallier JF, Villemant D, Devaux JY, Konno M, De Gournay JM, Armaganidis A, Iotti G, Huyghebaert MF : Bedside evaluation of right ventricular performance using a rapid computerized thermodilution method. Crit Care Med 1987; 15 : Fujiwara S, Motoki K, Oshika H, Tomobuchi Y, Ueno Y, Nishio I: Assessment of right ventricular function by magnetic resonance imaging of old myocardial infarction. J Cardiol 1995; 26 : in Jpn with Eng abstr 7 Jardin F, Gueret P, Dubourg O, Farcot JC, Margairaz A, Bourdarias JP : Right ventricular volumes by thermodilution in the adult respiratory distress syndrome: A comparative study using two-dimensional echocardiography as a reference method. Chest 1985; 88 : Urban P, Scheidegger D, Gabathuler J, Rutishauser W : Thermodilution determination of right ventricular volume and ejection fraction : A comparison with biplane angiography. Crit Care Med 1987; 15 : Siniorakis EE, Nikolaou NI, Sarantopoulos CD, Sotirelos KT, Iliopoulos NE, Bonoris PE : Volume loading in predominant right ventricular infarction: Bedside haemodynamics using rapid response thermistors. Eur Heart J 1994; 15: Hirsowitz GS, Lakier JB, Goldstein S : Right ventricular function evaluated by radionuclide angiography in acute myocardial infarction. Am Heart J 1984; 8: Walton S, Rowlands DJ, Shields RA, Testa HJ: Study of right ventricular function in ischaemic heart disease using radionuclide angiocardiography. Intensive Care Med 1979; 5: Takahashi M : Assessment of right ventricular function using gated blood pool single photon emission computed tomography in inferior myocardial infarction with or without hemodynamically significant right ventricular infarction. Kaku Igaku 1992 ; 29 : in Jpn with Eng abstr 13 Yoshino H, Udagawa H, Shimizu H, Kachi E, Kajiwara T, Yano K, Taniuchi M, Ishikawa K : ST-segment elevation in right precordial leads implies depressed right ventricular function after acute inferior myocardial infarction. Am Heart J 1998; 135: Zhang Y, Imai K, Araki Y, Nishino Y, Saito S, Ozawa Y, Yasugi T: Assessment of ejection fraction of the right and left ventricles in patients with acute myocardial infarction by magnetic resonance imaging. Jpn Circ J 1993 ; 57 : Braat SH, Ramentol M, Halders S, Wellens HJ : Reperfusion with streptokinase of an occluded right coronary artery: Effects on early and late right and left ventricular ejection fraction. Am Heart J 1987; 113: Yasuda T, Okada RD, Leinbach RC, Gold HK, Phillips H, McKusick KA, Glover DK, Boucher CA, Strauss HW : Serial evaluation of right ventricular dysfunction associated with acute inferior myocardial infarction. Am Heart J 199; 119: Lim YJ, Masuyama T, Nanto S, Mishima M, Kodama K, Hori M : Left ventricular papillary muscle perfusion assessed with myocardial contrast echocardiography. Am J Cardiol 1996; 78 : Sakuma T, Hayashi Y, Shimohara A, Shindo T, Maeda K : Usefulness of myocardial contrast echocardiography for the assessment of serial changes in risk area in patients with acute myocardial infarction. Am J Cardiol 1996 ; 78 : J Cardiol 2 Oct; 4 :